Day 1 :
Burapha University, Thailand
Miss Tadsawiya Padkao is a lecturer in physical therapy program at Burapha university. She has been experienced in clinical rehabilitation of COPD patients and elderly, and also, she interests investigate on impact of air pollution in northern and eastern of Thailand to pulmonary functions
Statement of the Problem: Expiratory airflow limitation is the pathophysiological significant of COPD that leads to air trapping and increases in dynamic hyperinflation (DH), consequently causes dyspnea during exercise and prolongs recovery time. Positive expiratory pressure (PEP) has been widely used in the management of lung where airway collapse is a problem. Therefore, the purpose of this study was to examine the effects of Conical-PEP, a new PEP device, on DH and recovery time in COPD. Methodology: A crossover study, which had been approved by the local ethics committee, was carried out in 8 patients with mild to moderate COPD (Age 55.75±9.82 yrs, FEV1 58.00±8.77 %predicted, FEV1% 66.38±12.91). Patients undertook five-minute knee extension exercise at 30% of 1RM while breathing out through the mouth with (Conical-PEP) or without (Control) the device. DH was evaluated by change in the inspiratory capacity (IC) measured immediately at the end of exercise compared pre-exercise values. Recovery time was record when their heart rate was returned to HR resting. Respiratory rate (RR), expiratory time (Te) and mouth pressure were also measured during exercise. Conclusion & Significance: During exercise with Conical-PEP, positive expiratory mouth pressure was 12.85±4.03 cmH2O. IC was larger 0.18±0.10 liters in Conical-PEP than Control (2.8±0.1 vs 2.6±0.1liters, respectively, p<0.05). Te was prolonged compared to the Control condition (2.2±0.3 vs 1.5 ±0.2 s, respectively, p<0.05). RR in the Conical-PEP condition was slower compared to Control (19.0±1.7 vs 25.1±1.7 bpm, respectively, p<0.05). Recovery time of Conical-PEP was reduced 88.0±43.6 s compared to Control (290±51.4 vs 378±79 s, respectively, p<0.05). This study provides data indicating that Conical-PEP generates sufficiently high positive expiratory pressures to allow effective lung emptying and prevent DH during exercise and contribute to decrease recovery period in COPD. Further studies are indicated to determine how useful Conical-PEP can be for a wider population.
National Center for Geriatrics and Gerontology, Japan
Masaaki Kusunose is a pulmonologist working at the Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan. A few years ago, he used to work on basic experiment about the mechanism by which lung cancer cells acquire worse phynotype and how to intervene that alteration at the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine. He is now working as a physician and also engaged in clinical research related to the association between chronic lung diseases and frailty.
Introduction: Age is known to be a risk factor for COPD and also a predictor of mortality and hospital admission for exacerbations. Frailty is a geriatric syndrome recognized as a clinical state of physical, psychological and social vulnerability that embodies an increased risk of requirement of care. The purpose of this study is to explore the relationship between frailty and physiological and patient-reported outcomes (PROs) in subjects with stable COPD.
Methods: We administered the Kihon Checklist that has been validated for frailty screening. We also assessed patient-reported measurements of health status and dyspnea using the COPD Assessment Test (CAT), the St. George’s Respiratory Questionnaire (SGRQ), the Hyland Scale, the Medical Outcomes Study 36-item short-form (SF-36), the Baseline Dyspnea Index (BDI) and the Dyspnea-12 (D-12). We also measured pulmonary function.
Results: Of 79 consecutive COPD outpatients, 38 (48.1%), 24 (30.4%) and 17 (21.5%) subjects were classified as robust, prefrail and frail, by using the total score of the Kihon Checklist. That score was significantly correlated with the CAT score (Spearman’s rank correlation coefficient (Rs)=0.38, p<0.01), the SGRQ total score (Rs=0.65, p<0.01), the Hyland Scale score (Rs=-0.54, p<0.01), all subscale scores of the SF-36 (Rs=-0.64 to -0.31, p<0.01), the BDI score (Rs=-0.46, p<0.01) and the D-12 score (Rs=0.41, p<0.01). We found no or only weak correlations between the total score of the Kihon Checklist and lung function measurements. Using stepwise multiple regression analyses to identify the variables that predicted the total score of the Kihon Checklist, the SGRQ total score alone significantly explained 49.1% of the variance (p<0.01).
Conclusions: Frailty seems to be associated with PROs, especially health status, unlike lung function. Frailty should be assessed in addition to PROs separately from lung function as part of multidimensional analyses of COPD.
Milan University, Italy
Camilo Corbellini is a skilled Respiratory Physiotherapist, with experience in the treatment and research of respiratory diseases, in adult and elderly patients. Graduated in Brazil in 2002, since 2010 living, studying and working in Italy. MSc in Medical Sciences (Brazil) and in Respiratory Physiotherapy (Italy). PhD in Physiology at Milan University. Happy father.
The COPD causes a not fully reversible airway obstruction and also changes in the rib cage structure. Those modifications lead to respiratory muscles functional inefficiency that is strongly correlated to lung function loss. Specifically, the diaphragm undergoes a progressive process of muscle fibers shortening, a consequence of lung hyperinflation and dead space increase. This results in a chronic mechanical disadvantage that impairs diaphragm’s mobility. This impairment may worse in COPD exacerbations, improving after pulmonary rehabilitation. The diaphragmatic mobility (DM) is mostly assessed with techniques that exposes the patient to risks. The ultrasonography in M-mode is easy to use, is safe and measures directly the diaphragmatic dome displacement. The study aimed to determine whether the COPD, according to the subject’s COPD severity, impairs the DM and to verify DM improvements after an inpatient pulmonary rehabilitation. We performed lung function tests and diaphragmatic M-mode ultrasonography in COPD individuals and healthy subjects. Ultrasonography was performed during rest breathing and deep inspirations. The COPD subjects underwent a six-minute walk test and arterial blood gas analyzes. After initial screening, 46 COPD patients ended the rehabilitation. The mean characteristics of healthy individuals and COPD subjects. The DM during Rest Breathing and Deep Inspirations were correlated to FEV1 decrease (r=0.74; p<0.01 and r= - 0.8; p<0.01, respectively). (figure 1). The correlation were also positives between the Deep Inspiration and the Inspiratory Capacity (r= 0.64 with p<0.001). After the rehabilitation the DM increases during deep inspiration from 4.58cm±1.83cm to 5.45cm±1.56cm (p<0.01). We concluded that M-mode ultrasonography showed that DM impairment is correlated to lung function loss in COPD subjects. The patients who completed the rehabilitation improved the diaphragmatic mobility verified during deep inspirations.